Methods for analyzing the eye

ABSTRACT

Systems and methods for imaging an eye are disclosed. The systems and methods may include at least one plenoptic camera. The systems and methods may include an illumination source with a plurality of lights.

RELATED APPLICATIONS

This application is a continuation application of U.S. patentapplication Ser. No. 16/109,593, filed Aug. 22, 2018, titled SYSTEMS ANDMETHODS FOR ANALYZING THE EYE which is a divisional application of U.S.patent application Ser. No. 15/438,480, now U.S. Pat. No. 10,092,183,filed Feb. 21, 2017, titled SYSTEMS AND METHODS FOR ANALYZING THE EYE,which is a continuation-in-part of PCT Application Serial No.PCT/US2015/047747, filed Aug. 31, 2015, titled SYSTEMS AND METHODS FORANALYZING THE EYE, which claims the benefit of U.S. ProvisionalApplication 62/044,253, filed Aug. 31, 2014, titled SYSTEMS AND METHODSFOR ANALYZING THE EYE, the entire disclosures of which are expresslyincorporated by reference herein.

TECHNICAL FIELD

The present invention relates to one or more imaging systems includingat least one light source, optics, and at least one camera for capturingand recording images of a patient's eye. The invention further relatesto a system and methods for allowing an ophthalmologist to easily andconveniently recreate the slit-lamp examination by accessing thecaptured images.

BACKGROUND

Ophthalmologists use a variety of devices for imaging of a patient'seye, including slit-lamps, ophthalmoscopes, fundus cameras, and scanninglaser ophthalmoscopes (SLOs). The ophthalmic slit-lamp examination hasremained largely unchanged for over sixty years. The slit lamp is aversatile instrument used by ophthalmologists for examining a patient'seye. It consists of a microscope, an illumination source, and amechanical support system to facilitate positioning the illuminationsource at various angles with respect to the eye. Ophthalmologists andoptometrists typically examine the eye by first horizontally scanningacross the eye using various slit beam thicknesses and orientations toexamine the most anterior structures such as the cornea and conjunctiva.Then the examiner will adjust the focus plane posterior to horizontallyscan across the anterior chamber of the eye. The focus is then adjustedmore posteriorly to horizontally scan across the iris and anteriorcrystalline lens. The process is repeated again to examine the posterioraspect of the crystalline lens and anterior vitreous.

FIG. 1 shows a schematic view of a patient's eye. As shown in FIG. 1,the basic components of the eye 10 include a cornea 12, conjunctiva 14,an iris 16, a pupil 18, a crystalline lens 20, and a retina 22. Ananterior chamber 24 is provided behind the cornea 12. A posteriorchamber 40 is provided posterior of anterior chamber 24. The posteriorchamber 40 includes the lens 20 which is positioned by the suspensoryligaments 34 of the eye. An anterior capsule 31 separates the anteriorchamber 24 from a posterior chamber 40 and a posterior capsule 30separates the posterior chamber 40 from a chamber 32 which includes thevitreous humor. Light enters the front of the eye through the pupil 18,is focused and inverted by the cornea and lens 20, and is projected ontothe retina 22 at the back of the eye. The iris 16 functions as an“aperture” that opens and closes to regulate the amount of lightentering the eye. The cornea, iris, pupil and lens are often referred toas the anterior segment of the eye. The retina 22 is a multi-layeredstructure that converts received light into a neural signal through aprocess known as “signal transduction.” The photoreceptors on the retinaare known as rods and cones. These generate neural signals that arecommunicated to the brain by ganglion cells that form the optic nerve24.

Anterior segment ocular imaging (e.g., slit-lamp) photography allowsophthalmologists to document and record a given slit-lamp view of aneye. Similarly, slit-lamp video allows ophthalmologists to document andrecord a slit-lamp examination of a patient's eye. Traditional slit-lampphotography creates an image using a sensor placed in an optical systemat a plane optically conjugate to an object which is to be imaged. Thisis the plane at which the best focus is achieved and therefore the bestoptical resolution of features in the object results.

Most still and video photography slit-lamp units are created by mountinga camera in place of the viewing oculars or in conjunction with theviewing oculars through the means of a beam splitter. These traditionalmodalities of recording the slit-lamp exam are limited to either usingstill photography to capture a single moment of the examination, ortaking a video of one's own examination sequence of slit-beam focus,magnification, slit-beam height, width and angle of incidence. Anotherhealth care professional can view the video, but cannot alter any ofthese variables after the examination. Slit-lamp video also requires ahighly trained ophthalmologist or optometrist to perform theexamination. No system exists that allows an ophthalmologist oroptometrist to perform a virtual slit-lamp examination based on imagesobtained at an earlier time. Such a system using traditional cameraswould require a massive library of images of various slit-beam positionsand characteristics would be required, with numerous sequential imagesstored in at least the x- and z-axes.

A camera captures an image of the illuminated portion of the eyestructures via reflected light. Rays which emanate from a point withinthe object plane in multiple directions are captured by the opticalsystem and those rays converge to approximately a single point in theconjugate image plane. The set of rays which are summed at any imagepoint is generally constrained by physical apertures placed within theoptical assembly. The traditional sensor records the summation of theintensity of light in the plane of the detector. The measurementcontains the intensity distribution of light within the plane of thesensor but loses all information about the rays' direction before thesummation. Therefore the typical process of recording a traditionalimage does not record a very large fraction of the information containedin the light absorbed.

SUMMARY

In an exemplary embodiment of the present disclosure, an imaging systemfor imaging at least a portion of an eye of a patient is provided. Thesystem comprising a patient support adapted to position the eye of thepatient; a movable base moveable relative to the patient support; and anillumination system. The illumination system including at least onelight source producing light to illuminate the eye and an illuminationsystem support arm supporting the light source. The illumination systemsupport arm being supported by the moveable base and rotatable relativeto the moveable base. The system further comprising an observationsystem including a plenoptic camera configured to receive imaging raysproduced by reflection of light from the eye, and an observation systemsupport arm supporting the imaging system. The observation systemsupport arm being supported by the moveable base and rotatable relativeto the moveable base. The observation system further comprising astorage device operatively coupled to the plenoptic camera to receiveand store a plurality of images of the eye imaged by the plenopticcamera, each of the stored images having at least one associatedcomponent characteristic of one of the patient support, the movablebase, the illumination system, and the observation system. In oneexample, the illumination system further includes a slit forming devicewhich receives illuminating light produced by the at least one lightsource and provides a line of light to illuminate the eye, theillumination system support arm supporting the slit forming device andwherein the plenoptic camera receives imaging rays produced byreflection of the line of light from the eye. In another example, theillumination system includes a plurality of light sources arranged in anarray, the plurality of light sources each produce light to illuminatethe eye. In a variation thereof, an illumination characteristic of aportion of the plurality of light sources is adjusted through an inputdevice. In a refinement thereof, the illumination characteristic is oneof an intensity level and a wavelength spectrum. In another variationthereof, an illumination characteristic of a portion of the plurality oflight sources is adjusted through an electronic controller. In arefinement thereof, the illumination characteristic is one of anintensity level and a wavelength spectrum. In a further example, theobservation system support arm is rotatable relative to the moveablebase independent of the illumination system support arm. In yet afurther example, the illumination system support arm is rotatablerelative to the moveable base about a first rotation axis and theobservation system support arm is rotatable relative to the moveablebase about the first rotation axis.

In another exemplary embodiment, a method of analyzing an eye of apatient which has been illuminated with a slit-lamp microscope isprovided. The slit-lamp microscope including an illumination system andan observation system. The illumination system including a light sourceand a slit forming device which provides a line of light to illuminatethe eye and the observation system including an imaging system includinga plenoptic camera configured to receive imaging rays produced byreflection of the line of light from the eye. The method comprising thesteps of storing a plurality of images of the eye imaged by theplenoptic camera while the eye was illuminated with the line of light,each of the stored images having at least one associated slit-lampmicroscope characteristic; receiving an image request; and providing arequested image based on at least one of the plurality of images, theimage request, and the at least one associated slit-lamp microscopecharacteristic of the at least one of the plurality of images. In oneexample, the requested image includes the line of light focused on afirst portion of a curved structure. In another example, the methodfurther comprises the steps of receiving an image request for a secondimage having the line of light focused on a second portion of the curvedstructure, wherein the line of light is displaced in at least one of anx-axis direction and a y-axis direction and in a z-axis direction; andgenerating the second image from at least one of the stored images andthe light field data of the at least one stored image. In a furtherexample, the method further comprises the step of requesting to walkthrough the stored images sequentially. In yet a further example, themethod further comprises the steps of retrieving an image set from aprior examination; and identifying an image from the prior examinationhaving the same associated slit-lamp microscope characteristic as therequested image. In yet a further example, the associated slit-lampmicroscope characteristic is one or more of an x-axis position of amoveable base of the slit-lamp supporting the illumination system andthe observation system, a y-axis position of the moveable base, a z-axisposition of the moveable base, a rotational position of the illuminationsystem, a rotational position of the observation system, a slit width ofthe slit-forming device, and a magnification of the observation system.In still yet another example, the method further comprises the steps ofreceiving an image request for a second image having the line of lightfocused on at a different depth within the eye than the first image; andgenerating the second image from at least one of the stored images andthe light field data of the at least one stored image.

In yet another exemplary embodiment of the present disclosure, animaging system for imaging at least a portion of an eye of a patient isprovided. The system comprising a patient support adapted to positionthe eye of the patient; an illumination system including a light sourceproducing light to illuminate the eye; and an observation systemincluding a plurality of cameras in a spaced apart arrangement, eachcamera positioned to receive imaging rays produced by reflection oflight from the eye. In one example, each camera has an optical axis andthe plurality of optical axes are parallel. In another example, theplurality of cameras are arranged along a line generally perpendicularto the optical axes of the plurality of cameras. In a further example,each camera has an optical axis and the plurality of optical axesconverge towards a common point. In a variation thereof, the pluralityof cameras are arranged along an arc. In a refinement thereof, the arcis a circular arc and the common point is a center of the circular arc.In still another example, the plurality of cameras are plenopticcameras.

In a further exemplary embodiment of the present disclosure, a method ofanalyzing an eye of a patient is provided. The method comprising thesteps of illuminating the eye with an illumination system, theillumination system including a light source and a slit forming devicewhich provides a line of light to illuminate the eye; positioning afirst camera relative to the eye to receive imaging rays produced by areflection of the line of light from the eye; positioning a secondcamera relative to the eye to receive imaging rays produced by thereflection of the line of the light from the eye; and storing aplurality of images of the eye imaged by the first camera and the secondcamera while the eye was illuminated with the line of light. In oneexample, each of the first camera and the second camera have an opticalaxis which are parallel to each other. In a variation thereof, the firstcamera and the second camera are arranged along a line generallyperpendicular to the optical axes of the first camera and the secondcamera. In another example, each of the first camera and the secondcamera have an optical axis that converge towards a common point. Inanother variation thereof, the first camera and the second camera arearranged along an arc. In a refinement thereof, the arc is a circulararc and the common point is a center of the circular arc. In a furtherrefinement thereof, the plurality of cameras are plenoptic cameras.

In yet a further exemplary embodiment of the present disclosure, animaging system for imaging at least a portion of an eye of a patient isprovided. The system comprising a patient support adapted to positionthe eye of the patient; an illumination system including a light sourceproducing light to illuminate the eye; and an observation systemincluding imaging optics configured to receive imaging rays produced byreflection of light from the eye which are focused by the imaging opticsat a first object plane, a first observation unit including a viewfinderwhich receives imaging rays from the imaging optics and a secondobservation unit which receives the imaging rays from the imagingoptics, the second observation unit including a plenoptic camera and adisplay, the second observation unit displaying an image of the eyegenerated based on the imaging rays, the image of the eye being focusedat a second object plane spaced apart from the first object plane. Inone example, the imaging system further comprises a beamsplitter, theimaging rays reaching the viewfinder through a first path through thebeamsplitter and reaching the plenoptic camera through a second paththrough the beamsplitter. In another example, the first object plane isoffset from the second object plane. In a further example, theillumination system includes a plurality of light sources arranged in anarray, the plurality of light sources each produce light to illuminatethe eye. In a variation thereof, an illumination characteristic of aportion of the plurality of light sources is adjusted through an inputdevice. In a refinement thereof, the illumination characteristic is oneof an intensity level and a wavelength spectrum.

In yet still another exemplary embodiment of the present disclosure, amethod of analyzing an eye of a patient is provided. The methodcomprising the steps of illuminating the eye with an illuminationsystem; receiving with imaging optics imaging rays produced byreflection of light from the eye; directing the imaging rays to aviewfinder; directing the imaging ray to a plenoptic camera; focusingthe imaging optics on a first object plane in the eye; and displaying ona display operatively coupled to the plenoptic camera a second objectplane in the eye. In one example, the first object plane is offset fromthe second object plane. In a variation thereof, the first object planetake into account at least one of an optical power of the viewfinder andthe optical power of an operator's eyes such that the resultant imageviewed by the operator through the viewfinder is focused at the secondobject plane.

In still a further exemplary embodiment of the present disclosure, animaging system for imaging at least a portion of a left eye of a patientand at least a portion of a right eye of the patient is provided. Thesystem comprising a patient support adapted to position the left eye andthe right eye of the patient; at least one illumination system includingat least one light source producing light to illuminate the left eye andthe right eye; a first observation system including a first plenopticcamera configured to receive imaging rays produced by reflection oflight from the left eye; a second observation system including a secondplenoptic camera configured to receive imaging rays produced byreflection of light from the right eye; and a storage device operativelycoupled to the first plenoptic camera and to the second plenoptic camerato receive and store a plurality of images of the eye imaged by thefirst plenoptic camera and the second plenoptic camera. In one example,the at least one illumination system includes a first illuminationsystem including at least a first light source producing light toilluminate the left eye and a second illumination system including atleast a second light source producing light to illuminate the right eye.

In a further exemplary embodiment of the present disclosure, a method ofanalyzing an eye of a patient with an imaging system including anillumination system and an observation system is provided. Theillumination system includes a light source. The observation systemincluding an imaging system including a camera configured to receiveimaging rays produced by reflection of light from the eye. The methodcomprising the steps of capturing images of a portion of the eye overtime with the camera; monitoring a position of a structure of the eye inthe captured images; determining if the structure of the eye is movingtowards an unsafe location; and if the structure is moving towards anunsafe location, providing feedback of such movement. In one example,the method further comprises the step of providing a signal to inhibitoperation of an instrument which is used to alter a portion of the eye.In a variation thereof, the instrument is an ultrasound probe. Inanother example, the step providing feedback of such movement includesat least one of providing an audio output, providing a visual output,and providing a tactile output. In a further example, the camera is aplenoptic camera. In a variation thereof, the structure is a posteriorcapsule of the eye and the step of determining if the structure of theeye is moving towards the unsafe location includes the step ofdetermining if the posterior capsule is moving forward towards theanterior side of the eye. In a refinement thereof, the step ofdetermining if the structure of the eye is moving towards the unsafelocation includes the step of determining whether the movement of thestructure has exceeded a threshold amount. In yet a further example, thestep of determining if the structure of the eye is moving towards theunsafe location includes the step of determining whether the movement ofthe structure has exceeded a threshold amount.

In a yet further exemplary embodiment of the present disclosure, amethod of analyzing an eye of a patient with an imaging system includingan illumination system and an observation system is provided. Theillumination system includes a light source. The observation systemincluding a camera configured to receive imaging rays produced byreflection of light from the eye. The method comprising the steps ofcapturing images of a portion of the eye over time with a plenopticcamera; determining positions of one of more structures of the eye fromthe captured images; and identifying a first intraocular lens from alibrary of intraocular lenses for placement in the eye based on thedetermined positions. In one example, the step of identifying the firstintraocular lens from the library of intraocular lenses for placement inthe eye based on the determined positions includes the step of comparingthe determined positions of the one or more structures of the eye with adatabase of determined positions for historical patients and a rating ofthe selected intraocular lens for the historical patients. In avariation thereof, the determined positions includes a distance betweenan anterior capsule of the eye and an posterior capsule of the eye and aposition of suspensory ligaments of the eye relative to one of theanterior capsule and the posterior capsule. In a refinement thereof, thedatabase also includes a measure of the final position of a replacementlens of the historical patients and the step of identifying a firstintraocular lens identifies the a first lens if the measure has a firstvalue indicating the final position of the lens for a historical patientwas as expected and a second lens if the measure has a second valueindicating that the final position of the lens for the historicalpatient was different than expected, the second lens having a differentoptical power than the first lens.

In still another exemplary embodiment of the present disclosure, animaging system for imaging at least a portion of an eye of a patient isprovided. The system comprising a patient support adapted to positionthe eye of the patient; an illumination system including a plurality oflight sources, each producing light to illuminate the eye; and anobservation system including imaging optics configured to receiveimaging rays produced by reflection of light from the eye. In oneexample, the observation system includes a plenoptic camera whichreceives the imaging rays from the imaging optics. In a variationthereof, the imaging system further comprises a storage deviceoperatively coupled to the plenoptic camera to receive and store aplurality of images of the eye imaged by the plenoptic camera, each ofthe stored images having at least one associated componentcharacteristic of one of the illumination system and the observationsystem. In another example, the illumination system further includes aslit forming device which receives illuminating light produced by the atleast one light source and provides a line of light to illuminate theeye and wherein the plenoptic camera receives imaging rays produced byreflection of the line of light from the eye. In still another example,the plurality of light sources are arranged in an array. In a variationthereof, an illumination characteristic of a portion of the plurality oflight sources is adjusted through an input device. In a refinementthereof, the illumination characteristic is one of an intensity leveland a wavelength spectrum. In another variation, an illuminationcharacteristic of a portion of the plurality of light sources isadjusted through an electronic controller. In a refinement thereof, theillumination characteristic is one of an intensity level and awavelength spectrum.

In still another exemplary embodiment of the present disclosure, amethod of analyzing an eye of a patient is provided. The methodcomprising the steps of illuminating the eye with an illuminationsystem, the illumination system including a plurality of light sources;receiving with imaging optics imaging rays produced by reflection oflight from the eye; directing the imaging rays to a camera to capture animage; displaying the image; and adjusting an illuminationcharacteristic of a portion of the plurality of light sources to alteran illumination of a portion of the eye. In one example, theillumination characteristic is one of an intensity level and awavelength spectrum. In another example, the illumination characteristicis adjusted to reduce glare at the portion of the eye.

While multiple embodiments are disclosed, still other embodiments of thepresent invention will become apparent to those skilled in the art fromthe following detailed description, which shows and describesillustrative embodiments of the invention. Accordingly, the drawings anddetailed description are to be regarded as illustrative in nature andnot restrictive.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a schematic view showing the basic components of thehuman eye;

FIG. 1A illustrates an enlarged view of a portion of FIG. 1;

FIG. 2 illustrates an exemplary examination system of the presentdisclosure with an optical axis of an illumination system being angledrelative to an optical axis of an observation system;

FIG. 2A illustrates an exemplary embodiment of a plenoptic cameraincluding a lenticular array of lenses;

FIG. 2B illustrates an exemplary embodiment of a plenoptic cameraincluding a mask;

FIG. 3 illustrates the examination system of FIG. 2 with the opticalaxis of the illumination system being generally aligned with the opticalaxis of the observation system;

FIG. 4 illustrates a side view of an exemplary embodiment of theexamination system of FIG. 2;

FIG. 5 illustrates a top view of the examination system of FIG. 4;

FIG. 6 illustrates an exemplary slit-lamp microscope of the presentdisclosure;

FIG. 7 illustrates an exemplary optical layout for the slit lampmicroscope of FIG. 6;

FIG. 8 illustrates an exemplary image of a fully illuminated (no slit)image of an eye under examination which may be obtained with the slitlamp microscope of FIG. 6;

FIG. 9 illustrates an exemplary image of a slit of light focused on thecornea of an eye under examination which may be obtained with the slitlamp microscope of FIG. 6;

FIG. 10 illustrates an exemplary image of a slit of light focused on thefront side of the lens of an eye under examination which may be obtainedwith the slit lamp microscope of FIG. 6;

FIG. 11 illustrates an exemplary image of a slit of light illuminating across section of the lens of an eye under examination which may beobtained with the slit lamp microscope of FIG. 6;

FIG. 12 illustrates an exemplary examination procedure with the slitlamp microscope of FIG. 6;

FIG. 13 illustrates another exemplary examination procedure with theslit lamp microscope of FIG. 6;

FIG. 14 illustrates an exemplary controller of the slit lamp microscopeof FIG. 6 and an exemplary remote controller;

FIG. 15 illustrates an exemplary arrangement of information stored foran examination with the slit lamp microscope of FIG. 6;

FIG. 16 illustrates an exemplary image of a slit of light illuminating aportion of the conjunctiva on a first side of the pupil which may beobtained with the slit lamp microscope of FIG. 6 while performing theexamination procedure of FIG. 12;

FIG. 17 illustrates an exemplary image of a slit of light illuminating aportion of the iris on the first side of the pupil which may be obtainedwith the slit lamp microscope of FIG. 6 while performing the examinationprocedure of FIG. 12;

FIG. 18 illustrates an exemplary image of a slit of light illuminating aportion of the iris on at a first side edge of the pupil which may beobtained with the slit lamp microscope of FIG. 6 while performing theexamination procedure of FIG. 12;

FIG. 19 illustrates an exemplary image of a slit of light illuminating aportion of the iris at the center of the pupil which may be obtainedwith the slit lamp microscope of FIG. 6 while performing the examinationprocedure of FIG. 12;

FIG. 20 illustrates an exemplary image of a slit of light illuminating aportion of the iris on at a second side edge of the pupil which may beobtained with the slit lamp microscope of FIG. 6 while performing theexamination procedure of FIG. 12;

FIG. 21 illustrates an exemplary image of a slit of light illuminating aportion of the iris on the second side of the pupil which may beobtained with the slit lamp microscope of FIG. 6 while performing theexamination procedure of FIG. 12;

FIG. 22 illustrates an exemplary processing sequence of a controller ofthe present disclosure;

FIG. 23 illustrates an example of refocusing with the system of thepresent disclosure;

FIGS. 24A-24E illustrate an example of refocusing with the system of thepresent disclosure;

FIG. 25 illustrates an exemplary optical microscope of the presentdisclosure;

FIG. 25A illustrates an exemplary processing sequence of a controller ofthe present disclosure;

FIG. 25B illustrates an exemplary processing sequence of a controller ofthe present disclosure;

FIG. 26 illustrates an exemplary examination system of the presentdisclosure;

FIG. 27 illustrates an exemplary arrangement of a plurality of lightsources of an illumination system;

FIG. 28 illustrates an exemplary intensity level map for the pluralityof light sources of FIG. 27;

FIG. 29 illustrates an exemplary processing sequence of a controller ofthe present disclosure;

FIG. 30 illustrates an exemplary examination system of the presentdisclosure;

FIG. 31 illustrates an exemplary arrangement of a plurality of camerasof an observation system;

FIG. 32 illustrates another exemplary arrangement of a plurality ofcameras of an observation system; and

FIG. 33 illustrates an exemplary examination system of the presentdisclosure.

While the invention is amenable to various modifications and alternativeforms, specific embodiments have been shown by way of example in thedrawings and are described in detail below. The intention, however, isnot to limit the invention to the particular embodiments described. Onthe contrary, the invention is intended to cover all modifications,equivalents, and alternatives falling within the scope of the inventionas defined by the appended claims.

DETAILED DESCRIPTION OF THE DRAWINGS

Before any embodiments of the disclosure are explained in detail, it isto be understood that the disclosure is not limited in its applicationto the details of construction and the arrangement of components setforth in the following description or illustrated in the followingdrawings. The disclosure is capable of other embodiments and of beingpracticed or of being carried out in various ways. The term “a” or “an”entity refers to one or more of that entity. As such, the terms “a” (or“an”), “one or more” and “at least one” may be used interchangeablyherein. It is also to be noted that the terms “comprising”, “including”,and “having” may be used interchangeably.

The term “logic” or “control logic” as used herein may include softwareand/or firmware executing on one or more programmable processors,application-specific integrated circuits (ASICs), field-programmablegate arrays (FPGAs), digital signal processors (DSPs), hardwired logic,or combinations thereof. Therefore, in accordance with the embodiments,various logic may be implemented in any appropriate fashion and wouldremain in accordance with the embodiments herein disclosed.

Referring to FIG. 2, an examination system 100 is shown. Examinationsystem 100 includes an illumination system 102 and an observation system104. Illumination system 102 illuminates eye 10 with light generally indirection 106 along an optical axis 108. Observation system 104 receivesreflected light from eye 10 generally in direction 110 along an opticalaxis 112. As shown in FIG. 2, optical axis 112 is generally aligned withan optical axis 28 of eye 10 and optical axis 108 is angled relative tooptical axis 112 by an angle 111. In one embodiment, optical axis 108and optical axis 112 are generally coplanar. Although illuminationsystem 102 and observation system 104 are shown with observation system104 being positioned directly in front of eye 10 and aligned with axis28 of the eye 10 and illumination system 102 being angled relative toeye 10, illumination system 102 and observation system 104 may bepositioned in any relationship to eye 10. In one embodiment,illumination system 102 and observation system 104 are both angledrelative to the optical axis 28 of the eye 10. In one embodiment,illumination system 102 is positioned directly in front of eye 10 withoptical axis 108 aligned with optical axis 28 of eye 10 and observationsystem 104 is positioned with optical axis 112 angled relative tooptical axis 28 of the eye 10.

In one embodiment, examination system 100 includes a secondary diffuseillumination source 114 which illuminates portions of the eye notilluminated by the brighter illumination source of illumination system102. The illumination source 114 may be any light source which providesa generally constant light intensity across a large portion of the eye10. In one example, secondary diffuse illumination source 114 issupported by illumination system 102. In one example, secondary diffuseillumination source 114 is separate from illumination system 102.

Observation system 104 includes a plenoptic camera 130. Plenoptic camera130 records light field data associated with the light reflected fromeye 10. The light field data permits refocusing of an image recorded bythe plenoptic camera 130. Plenoptic camera 130 is operatively coupled toa controller 300. As explained herein, controller 300 stores the imagesrecorded by plenoptic camera 130 and processes image requests. Exemplaryplenoptic cameras are the Lytro Illium brand camera available fromLytro, Inc. located at 1300 Terra Bella Avenue in Mountain View, Calif.94043 and the R5, R11, R29, and RX camera models sold by Raytrix GmbHlocated at Schauenburgerstrasse 116 D-24118 in Kiel, Germany. Furtherexemplary plenoptic cameras and/or systems for processing imagesrecorded by plenoptic cameras are disclosed in U.S. Pat. Nos. 7,706,632;7,936,392; 7,956,924; 8,228,417; 8,238,738; 8,289,440; 8,471,897,8,593,564; 8,619,177, US20130010260; US20130222633, US20140078259;US20140129988; US20140016019; US20140013273; US20130235267;US20130222652, US20130222606, US20130113981, US20130033636,US20120327222; US20120294590; US20120249550; US20110234841, thedisclosures of which are expressly incorporated by reference herein.

Referring to FIG. 2A, in one embodiment, a plenoptic camera 130 includesa sensor array 170 at or near the back focal plane 172 of a lens array(lenticular array) 174. Sensor array 170 includes a plurality ofdetectors which form pixels in a resultant image. In this way, a rayenters camera 130 passes through a main lens or lenses 176 and thenencounters lens array 174. The ray is constrained in position by theindividual lens in the array (lenslet) through which it passed, and inangle by the specific sensor pixel it is incident upon behind thelenticular array 174.

Referring to FIG. 2B, in one embodiment, a plenoptic camera 130 includesa sensor array 170 at or near the back focal plane 172 of a mask 180 inplace of the lenticular array 174. Sensor array 170 includes a pluralityof detectors which form pixels in a resultant image. A ray enters camera130 passes through a main lens 176 and then encounters mask 180. In oneembodiment, the mask 180 is a patterned mask. Additional detailsregarding an exemplary plenoptic camera that utilizes a mask instead ofa lenticular array are provided in (1) Veeraraghavan, A., Raskar, R.,Agrawal, A., Mohan, A., Tumblin, J. (2007). “Dappled Photography: MaskEnhanced Cameras for Heterodyned Light Fields and Coded ApertureRefocusing”, Proc. ACM SIGGRAPH; (2) Veeraraghavan, A., Raskar, R.,Agrawal, A., Mohan, A., Tumblin, J. (July 2007). “Dappled Photography:Mask Enhanced Cameras for Heterodyned Light Fields and Coded ApertureRefocusing”, MITSUBISHI ELECTRIC RESEARCH LABORATORIES,http://www.merl.com; and (3) U.S. Pat. No. 7,965,936, titled 4D lightfield cameras, the disclosures of which are expressly incorporated byreference herein.

An additional exemplary plenoptic camera 130 is disclosed in MANAKOV,Alkhazur et al., A Reconfigurable Camera Add-On for High Dynamic Range,Multispectral, Polarization, and Light-Field Imaging, ACM Transactionson Graphics, Association for Computing Machinery, 2013, Proceeding ofSIGGRAPH, 32 (4), pp. 47:1-47-14, the disclosure of which is expresslyincorporated by reference herein, wherein an apparatus is added betweenthe imaging plane of a main lens group of a camera and the imagingsensor of the camera. The apparatus includes a pupil matching lenslocated at the image plane of the main lens group of the camera. Theapparatus further includes a kaleidoscope-like arrangement of mirrorswhich creates multiple views of the image passing through the pupilmatching lens, each with a different perspective shift. The multipleimages are then cast to the imaging sensor of the camera.

Referring to FIG. 3, examination system 100 is shown wherein opticalaxis 108 is generally coaxial with optical axis 112 and with opticalaxis 28 of the eye 10. Thus, observation system 104 is generally in linewith illumination system 102. Although illumination system 102 andobservation system 104 are shown being positioned directly in front ofeye 10 and aligned with optical axis 28, illumination system 102 andobservation system 104 may be angled relative to optical axis 28 of theeye 10, such as the position of illumination system 102 in FIG. 2.Further, the illumination system 102 and observation system 104 may beparallel with optical axis 28 of the eye, but offset from the opticalaxis 28 of the eye 10.

Referring to FIGS. 4 and 5, an exemplary embodiment of examinationsystem 100 is shown. Illumination system 102 and observation system 104are shown supported by a moveable base 140 which is supported on top ofa base 142. In one embodiment, base 142 is the floor, a table-top, or anintermediate base which is supported by the floor or tabletop or otherstructure in an examination room. A patient support 144 is alsosupported by base 142. Patient support 144 positions an eye 10 of apatient relative to illumination system 102 and observation system 104.

Referring to FIG. 5, moveable base 140 is generally moveable in anx-axis in direction 146 and direction 148 relative to base 142 and in az-axis in direction 150 and direction 152 relative to base 142. Themovement of moveable base 140 relative to base 142 results in themovement of both illumination system 102 and observation system 104. Inone embodiment, one of illumination system 102 and observation system104 is not supported by moveable base 140 and thus does not move inconcert with moveable base 140 when moveable base 140 is moved relativeto base 142.

Illumination system 102 and observation system 104 are both moveablerelative to moveable base 140 in a y-axis in direction 154 and direction156 as illustrated in FIG. 4. Further, each of illumination system 102and observation system 104 are rotatable relative to moveable base 140in direction 158 and direction 160 as illustrated in FIG. 5. In theillustrated embodiment, each of illumination system 102 and observationsystem 104 are rotatable about an axis 162. Illumination system 102 andobservation system 104 are individually rotatable relative to moveablebase 140. As such, illumination system 102 may be rotated relative tomoveable base 140 without a corresponding rotation of observation system104 relative to moveable base 140 or vice versa.

Although illumination system 102 and observation system 104 are shownbeing rotatable about a vertical axis, axis 162, one or both ofillumination system 102 and observation system 104 may be rotatableabout a horizontal axis parallel to the x-axis or another axis in aplane defined by the x-axis and the y-axis. In one embodiment, each ofillumination system 102 and observation system 104 is rotatable about aseparate axis relative to moveable base 140.

Referring to FIG. 6, an exemplary embodiment of examination system 100is shown. A slit-lamp microscope 200 is illustrated in FIG. 6. Slit-lampmicroscope 200 is supported on a base 202. Slit-lamp microscope 200includes an intermediate base 204 supporting a patient support 206 and amoveable base 208. Patient support 206 includes a jaw support 210 and aforehead support 212 which support and position the eye 10 of thepatient. Moveable base 208 is moveable relative to intermediate base 204in the directions (x-axis and z-axis) discussed in connection with FIG.5 for the movement of moveable base 140 relative to base 142. In oneembodiment, moveable base 208 is moveable relative to intermediate base204 in the x-axis, the y-axis, and the z-axis as discussed in connectionwith FIGS. 4 and 5. An exemplary system for movement in the y-axis isdisclosed in U.S. Pat. No. 8,434,869, the disclosure of which isexpressly incorporated by reference herein. In this embodiment, amovement in the y-direction is caused in response to a rotation of aknob 216 supported by the moveable base 208.

Moveable base 208 supports an illumination system 220 and an observationsystem 222. Illumination system 220 is moveable relative to moveablebase 208 in the translation and rotation directions discussed inconnection with FIGS. 4 and 5 for the movement of illumination system102 relative to moveable base 140. Observation system 222 is moveablerelative to moveable base 208 in the translation and rotation directionsdiscussed in connection with FIGS. 4 and 5 for the movement ofobservation system 104 relative to moveable base 140. Illuminationsystem 220 and observation system 222 are moveable relative to eachother as discussed in connection with FIGS. 4 and 5 for the relativemovement of illumination system 102 and observation system 104.

Referring to FIG. 7, illumination system 220 includes a light source 224and condenser lenses 226 and 228 for converging the light from the lightsource 224. Exemplary light sources include 224 a halogen lamp, an LEDsource, or other suitable light source. In one embodiment, illuminationsystem 220 includes a strobe light source such as a xenon lamp. In oneembodiment, illumination system 220 further includes a diffuse lightillumination source 114. An example of the eye 10 illuminated withdiffuse light illumination source 114 is shown in FIG. 8.

Illumination system 220 further includes a slit 230 for allowing only apart of the light passing through the condenser lenses 226 and 228 topass through the slit 230 and out of illumination system 220. The lightpassing through slit 230 provides a narrow generally rectilinear beam oflight 236 (see FIG. 9) which impinges upon eye 10 of the patient.

In one embodiment, illumination system 220 includes a filter 238 whichlimits the color of light that progresses through illumination system220 and is ultimately used to illuminate eye 10. An exemplary filterwould be cobalt blue to view fluorescein staining. Other exemplaryfilters may be used.

Slit 230 has an adjustable width to vary the width of the generallyrectilinear beam of light which impinges upon eye 10 of the patient. Inone embodiment, a width of slit 230 may be increased to providegenerally full illumination of eye 10 of the patient. Exemplary widthsfor slit 230 are 1 mm and a thin slit having a width of up to about 1mm. Further exemplary slit widths are in the range of about 0.2 mm toabout 1.0 mm. In one embodiment, slit 230 is controlled through a knobor dial provided on illumination system 220. In one embodiment, slit 230is automatically controlled through a computing system. An exemplarysystem for adjusting a width of slit 230 is provided in European PatentApplication No. EP2695572, the disclosure of which is expresslyincorporated by reference herein.

Illumination system 220 further includes a condenser lens 232 forconverging the light that has passed through the slit 230 onto the eye10 of the patient. The above-described slit 230 and the eye 10 to beexamined are located in a conjugative position relative to the condenserlens 232 so that a local illumination ray of the slit 230 is projectedto, for example, the cornea of the eye 10 to be examined. Light fromslit 230 reaches eye 10 through a reflection from half-mirror 240. Thelight reflected from eye 10 is returned towards half-mirror 240 andpasses through half-mirror 240 to reach observation system 222.

In one embodiment, illumination system 220 includes a collimator systemwhich focuses the light from the source and then uses a collimator lensto produce a collimated beam of light emitting from light source 224. Aportion of the collimated beam passes through slit 230 and is incidentupon eye 10 of the patient. In one embodiment the light source is awhite light source. In one embodiment the collimated beam is filtered tolimit the color of the light that progresses through the illuminationsystem and ultimately to illuminate eye 10.

In one embodiment, illumination system 220 includes light source 600described in further detail herein with regard to FIGS. 26-28. Asexplained herein, light source 600 includes a plurality of individuallycontrolled light sources whose optical characteristics may be adjustedto alter the illumination pattern on eye 10.

Observation system 222 includes an objective lens 250, a zooming opticalsystem 252, a condenser lens 254, a beam splitter 256, a relay lens 258,a prism 260 for changing the optical path on the side of the housing ofobservation system 222 and an ocular lens 262. The image of the eye 10is formed on an imaging point 264 and may be observed by the eye 266 ofthe person conducting the eye exam. The zooming optical system 252changes a magnification of the image of eye 10.

Beamsplitter 256 also directs a portion of the light enteringobservation system 222 to a condenser lens 270 which directs the lightinto a plenoptic camera 130 through a reflection from a mirror 272. Inone embodiment, plenoptic camera 130 is a still image camera. In oneembodiment, plenoptic camera 130 is a video camera. In both embodiments,plenoptic camera 130 is used to capture a plurality of images of the eye10 for subsequent examination as discussed herein. Plenoptic camera 130captures both the position and direction of light propagating in space.

Referring to FIG. 8, an exemplary image 280 of eye 10 is shown. Image280 is a fully illuminated (no slit) image of eye 10. In one embodiment,eye 10 is illuminated with diffuse light source 114. In one embodiment,eye 10 is illuminated with light source 224 and slit 230 is opened to awidth to permit full illumination of the eye 10.

Referring to FIG. 9, an exemplary image 282 of eye 10 is shown. Image282 illustrates a slit of light 236 focused on the cornea 12 of the eye10. The focus depth of the slit of light 236 may be altered by movingmoveable base 208 in either of direction 150 or direction 152. Further,the position of the slit of light 236 may be moved lateral relative toeye 10 by moving moveable base 208 in direction 146 or direction 148and/or illumination system 220 in direction 158 or direction 160.

Referring to FIG. 10, moveable base 208 is moved in direction 150thereby focusing the slit of light 236 onto a front surface of the lens18 of the eye. Referring to FIG. 11, moveable base 208 is moved furtherin direction 150 thereby illuminating a complete cross section of thelens 18 of the eye 10 with the slit of light 236.

Ophthalmologists and optometrists typically examine the eye 10 by firsthorizontally scanning across the eye using various slit beam thicknessesand orientations to examine the most anterior structures such as thecornea and conjunctiva. FIG. 12 illustrates an exemplary scan across theeye 10 wherein the illumination system 220 and the observation system222 are not rotated from an initial angular setting during theexamination. FIG. 13 illustrates an exemplary scan of the eye 10 whereinthe illumination system 220 is rotated relative to the observationsystem 222 during the examination.

Referring to FIG. 12, an exemplary examination which results in amovement of the slit of light 236 in direction 146 is shown. Slit-lampmicroscope 200 is positioned such that an optical axis 231 (see FIG. 7)of illumination system 220 is angled relative to an optical axis 251(see FIG. 7) of observation system 222. While maintaining illuminationsystem 220 relative to observation system 222, moveable base 208 ismoved in direction 146. In one embodiment, moveable base 208 is moved byan operator grasping a joystick input 216 (see FIG. 6). In oneembodiment, moveable base 208 is moved automatically under the controlof controller 300. In this embodiment, moveable base 208 includes one ormore devices to move moveable base 208. Exemplary devices includemotors, linear actuators, and other suitable devices. As moveable base208 is moved in direction 146, the slit of light moves across eye 10. Anexample with the slit of light illustratively marked as line of light450 is represented in the images shown in FIGS. 16-23 which arediscussed in further detail herein.

Referring to FIG. 13, an exemplary movement of the slit of light 236 indirection 158 is shown. Slit-lamp microscope 200 is positioned such thatan optical axis 231 of illumination system 220 is angled relative to anoptical axis 251 of observation system 222. While maintainingobservation system 222 relative to moveable base 208, illuminationsystem 220 is moved in direction 158. In one embodiment, illuminationsystem 220 is moved by an operator grasping the support structure ofillumination system 220 and rotating illumination system 220 about axis162. In one embodiment, illumination system 220 is moved automaticallyunder the control of controller 300. In this embodiment, illuminationsystem 220 includes one or more devices to move the illumination system220 relative to the moveable base 208. Exemplary devices include motorsand other suitable devices. As illumination system 220 is moved indirection 158, the slit of light 236 moves across eye 10.

Returning to FIG. 6, in the illustrated embodiment, controller 300monitors the use of slit-lamp microscope 200. Slit-lamp microscope 200includes a plurality of sensors that provide an indication of a setting,a position, or other characteristic of one or more components ofslit-lamp microscope 200. For example, moveable base 208 may support anx-axis sensor 310 and a z-axis sensor 312 which provide an indication ofthe position of moveable base 208 relative to intermediate base 204.Exemplary sensors include optical sensors, mechanical sensors,electrical sensors, and combinations thereof. In one example, a computermouse style trackball is received in a pocket in the bottom of moveablebase 208. The trackball rolls as moveable base 208 is moved in any oneof direction 146, direction 148, direction 150, and direction 152.Sensors 310 and 312 monitor the movement of the trackball and provide anindication of the position of moveable base 208 to controller 300. Ay-axis sensor 311 provides an indication of the position of illuminationsystem 220 and observation system 222 relative to moveable base 208. Inone embodiment, sensor 311 monitors a rotation of joystick input 216which elevates or lowers the illumination system 220 and observationsystem 222. The internal mechanism of joystick input 216 may be aninclined spiral thread.

Further, moveable base 208 may support an illumination system rotarysensor 314 and an observation system rotary sensor 316. Illuminationsystem rotary sensor 314 monitors a rotation of illumination system 220relative to moveable base 208. Observation system rotary sensor 316monitors a rotation of observation system 222 relative to moveable base208. Exemplary sensors include optical sensors, mechanical sensors,electrical sensors, and combinations thereof.

Slit-lamp microscope 200 further includes a slit sensor 318, a filtersensor 320, a diffuse light illumination sensor 321, and an illuminationsensor 322. Slit sensor 318 provides an indication of a slit widthsetting of slit 230. An exemplary system for monitoring a slit width isdisclosed in European Patent Application No. EP2695572, the disclosureof which is expressly incorporated by reference herein. Filter sensor320 provides an indication of whether a filter is placed in the lightbeam of illumination system 220. In one embodiment, a filter wheel isprovided and an angular position of the filter wheel is monitored.Diffuse light illumination sensor provides an indication of thebackground illumination power level of a diffuse light source 114 (seeFIG. 7). Illumination sensor 322 provides an indication of a powerintensity of light source 224. Slit-lamp microscope 200 further includesa magnification sensor 330 which provides an indication of amagnification setting of zooming optical system 252 of observationsystem 222.

In one embodiment, one or more of moveable base 208, illumination system220, observation system 222, slit 230, filter 238, light source 224,zooming optical system 252, and other settings of slit-lamp microscope200 are set through manual inputs. In one embodiment, one or more ofmoveable base 208, illumination system 220, observation system 222, slit230, filter 238, light source 224, zooming optical system 252, and othersettings of slit-lamp microscope 200 are set by controller 300controlling motors or other actuators.

Referring to FIG. 14, controller 300 includes one or more processors 350configured to execute instructions stored in memory 430 for receivingimages from plenoptic camera 130 and sensor information from moveablebase 208, illumination system 220, observation system 222, slit 230,filter 238, light source 224, zooming optical system 252. In addition,patient information 354 and examination information 356 may be stored inmemory 430.

Controller 300 includes one or more input devices 360 to receive inputfrom an operator of slit-lamp microscope 200. Exemplary input devicesinclude keys, buttons, joysticks, touch screens, dials, switches, mouse,and trackballs which providing user control of slit-lamp microscope 200.Controller 300 further includes one or more output devices 362 toprovide feedback or information to an operator. Exemplary output devicesinclude a display, lights, and/or audio devices which provide userfeedback or information.

In one embodiment, the information stored in memory 430 is madeavailable to additional controllers, illustratively controller 400, overa network 402. In one embodiment, the logic of controller 300 is alsomade available to controller 400 over network 402. An exemplary outputdevice 362 of controller 300 is a network access device which is capableof accessing network 402. An exemplary network access device is a modem.

Controller 400 includes input devices and output devices to receiveinput from an operator and to provide feedback or information to theoperator, respectively. An exemplary operator for controller 400 is anophthalmologist located remote from slit-lamp microscope 200. In oneembodiment, controller 400 includes the logic described herein ofcontroller 300 and retrieves images and related information over network402 from controller 300. This arrangement allows an ophthalmologist toreview examination data remotely from the slit-lamp microscope 200. Inthis manner an ophthalmologist is able to review a slit lamp exam remotefrom slit-lamp microscope 200. Further, since the images obtained duringthe initial examination or derived from the initial examination arestored on a memory of controller 400 or a memory accessible bycontroller 400 the ophthalmologist make review the slit lamp examinationat a later time than the original examination.

As shown in FIG. 14, controller 300 receives a plurality of images 410from plenoptic camera 130. For each image 410, controller 300 alsoreceives sensor data 412 related to one or more characteristics ofslit-lamp microscope 200. Exemplary sensor data includes slit sensordata 414 from slit sensor 318, filter sensor data 416 from filter sensor320, illumination sensor data 417 from illumination sensor 322,magnification sensor data 418 from magnification sensor 330, x-axissensor data 419 from x-axis sensor 310, y-axis sensor data 421 fromy-axis sensor 311, z-axis sensor data 420 from z-axis sensor 312,illumination system rotary sensor information 422 from illuminationsystem rotary sensor 314, observation system rotary sensor information424 from observation system rotary sensor 316, and diffuse illuminationsensor 425 from diffuse illumination sensor 321.

The plurality of images 410 and sensor data 412 is stored in memory 430.Memory 430 may include, but is not limited to, memory associated withthe execution of software and memory associated with the storage ofdata. Memory 430 includes non-transitory computer readable media.Computer-readable media may be any available media that may be accessedby one or more processors of controller 300 and includes both volatileand non-volatile media. Further, computer readable-media may be one orboth of removable and non-removable media. By way of example,computer-readable media may include, but is not limited to, RAM, ROM,EEPROM, flash memory or other memory technology, CD-ROM, DigitalVersatile Disk (DVD) or other optical disk storage, magnetic cassettes,magnetic tape, magnetic disk storage or other magnetic storage devices,or any other medium which may be used to store the desired informationand which may be accessed by controller 300.

In one embodiment, memory 430 also stores patient information 432 andexamination information 434. Exemplary patient information includes apatient name or other identifier, patient medical history, and othersuitable information. Exemplary examination information includes eyebeing examined, additional settings of slit-lamp microscope 200, andother suitable information. In one embodiment, controller 400 alsoincludes or has access to image data 410 and sensor data 412 along withthe logic of controller 300. As such, the discussions herein related tocontroller 300 apply equally to a remotely located controller, such ascontroller 400.

Referring to FIG. 15, a plurality of images may be grouped together. InFIG. 15, three groups of images, Image Set 1, Image Set 2, and Image Setn are illustrated. Sensor information 412 is provided for each of theimages. In one embodiment, plenoptic camera 130 records a video and thevideo clip is the image set which includes a plurality of frames. In oneembodiment, plenoptic camera 130 records still images and the operatorof slit-lamp microscope 200 signals with one of input devices 360 whento capture a still image. In one embodiment, plenoptic camera 130records still images and controller 300 automatically captures imagescorresponding to various preset sensor readings. For example, whenillumination system 220 is being rotated in direction 158, controller300 may execute logic to capture an image at set angular values ofillumination system rotary sensor 314.

An exemplary representation of Image Set 1 is provided in FIGS. 16-23.Referring to FIG. 16, Image 1A of Image Set 1 is shown. In Image 1A aline of light 450 produced by slit 230 is shown being positioned to theleft of iris 16. Advancing through Images 2A through 6A, line of light450 moves to the right, as shown in FIGS. 17-23. This movement of lineof light 450 to the right is due to a movement of moveable base 208 indirection 146.

The slit lamp microscope apparatus 200 described in this applicationpermits a technician with basic skills to obtain the light-field dataneeded to recreate a slit-lamp examination at a later time and in adifferent location. The light-field camera captures an image at a givenslit-beam size and angular orientation. A motorized apparatus moves theslit-beam along a horizontal axis to an adjacent or an overlappingposition where another high resolution light-field image would beobtained. This process is repeated multiple times to scan across thestructures of the eye. This scanning process can be repeated withslit-beams of various widths and angles of incidence to simulate thetypes of views obtained by an ophthalmologist using a traditionalslit-lamp. This scanning allows for libraries of adjacent light-fieldslit images to be created for the various slit-beam widths and angles.

Retroillumination and specular reflection views are also possiblethrough the careful placement of the illumination source and the viewingangle of the plenoptic camera 130. Non-slit illumination such as a ringlight or point-source of light can be utilized in a similar manner(especially for retroillumination through a pupil). During light-fielddata acquisition, images are evaluated in real time to discard errantimages, for example those associated with patient blinking, glare orpatient movement. One embodiment of the apparatus includes soft armsthat contact the upper and/or lower lids to allow for blink-freeimaging. Stabilization algorithms that use landmarks of the eye andother stabilization techniques may be used to improve both image qualityand the ability to collate adjacent images for later display. In oneembodiment, images are captured with illumination system 220 positionedat −45° from straight on center (see FIG. 13), straight on center, and45° from straight on center. For each setting of the illumination system220 the slit is moved across all the features in the eye as well as maybe changing the angle (may be not) for each one field illumination.

In one embodiment of the apparatus, the images obtained by thelight-field camera are analyzed in real-time to automatically place thefocus of the slit beam at various clinically important anatomicstructures of the eye. These can include the tear film, anterior cornea,posterior cornea, the anterior chamber midpoint, anterior lens capsule,central lens, posterior lens capsule. Although these focal planes can beretrospectively viewed with light-field processing, thin slit-beamillumination may not be simultaneously focused at each of these layers(unless collimated light is used).

Other embodiments of the apparatus allow for variable angles ofexamination. The typical slit-lamp sequence is performed with verticallyoriented slit-beams and horizontal movement of the viewing oculars, butthe orientation of the examination could be rotated 90 degrees(horizontal slit/vertical scanning) or to any oblique angle. Variouscombinations of slit-beam focal plane, slit size and angular orientationimaging can be pre-chosen via the apparatus software to balance theophthalmic completeness of the examination and the computational demandsrequired to recreate various slit-beam views.

Referring to FIG. 22, an exemplary processing sequence 460 of controller300 is illustrated. Controller 300 receives a request for an image or acharacteristic, as represented by block 462. Controller 300 provides arequested image based on at least one of the plurality of images, theimage request, and the associated slit-lamp microscope characteristic ofthe at least one of the plurality of images, as represented by block464.

In one example, a user through input devices 360 (or the respectiveinput devices of controller 400) requests a specific image or image setto be displayed. For instance, a user may want to first walk through theexamination as it was taken. Thus, the user may request the first imageof Image Set 1. In this case image selection logic 460 would return thefirst image of Image Set 1.

In another example, the user through input devices 360 (or therespective input devices of controller 400) requests the image closestto a given characteristic of slit-lamp microscope 200. For instance, theuser may want an image at the same x,y,z positioning of slit-lampmicroscope 200, but with a narrower slit width. In this case imageselection logic 460 would search the sensor data 412 stored in memory430 to determine which image has the closest x,y,z, position and anarrower slit width.

In a further example, the user requests an image offset from the currentimage in one of x,y,z or the rotational angle of illumination system 220or observation system 222. For instance, the user may want an image atthe same x,y positioning of slit-lamp microscope 200, but focused deeperinto the eye along the z-axis. Referring to FIG. 23, the object plane ofImage 5A is represented by line 470. Image 5A is generally focused alongthe z-axis on the cornea 12 of the eye 10. The user may want to stepthrough the eye 10 in direction 150 (deeper in the z-axis) asrepresented by lines 472-478. In this case refocus logic 480 ofcontroller 300 would utilize the “light field” data of the image torefocus at the requested z-depth. The systems and methods related to avariety of image reconstruction techniques using light-field data areprovided in US Patent Publication 2009/0041448 (Georgiev), U.S. Pat. No.7,936,392 (Ng), and the remaining patents and published applicationsidentified herein, the entire disclosures of which are incorporated byreference herein. In another instance, the user may want an image at thesame y,z positioning of slit-lamp microscope 200, but offset in thex-direction. Assuming another image is not already offset in the x-axisby the requested amount, perspective change logic 480 changes theperspective of the eye 10 along the x-axis. The systems and methodsrelated to a variety of image reconstruction techniques usinglight-field data are provided in US Patent Publication 2009/0041448(Georgiev), U.S. Pat. No. 7,936,392 (Ng), and the remaining patents andpublished applications identified herein, the entire disclosures ofwhich are incorporated by reference herein. In one embodiment,controller 300 may provide Scheimplug images of the eye from the lightfield data to provide different perspective views of the variousstructures of the eyes.

In a still further example, the user may request that multiple images becombined into a focal stack image wherein the in-focus portions ofmultiple image are combined or otherwise displayed together to generatean image having multiple depths along the z-axis in focus. In oneexample, the user may want to combine portions of multiple images,either taken during the examination or generated from the light fielddata, together to generate a focused image of a curved structure of theeye 10 which extends along the z-axis, such as the cornea 12 of the eye10.

In yet still a further example, the user may want to selectively focusthe z-axis on a clinically important structure such as the anteriorcornea 12, so that x or y axis movements would follow the curved anatomyof the cornea. Referring to FIG. 24A, a representation of the anteriorcornea 12 is shown. Referring to FIG. 24B, an example is shown for theslit positions corresponding to FIGS. 19-21 wherein the software logicdoes not use the light field data to refocus in the z-direction as slit450 is moved along the x-direction. In contrast, as shown in FIG. 24C,an example is shown for the slit 450 positions corresponding to FIGS.19-21 wherein the software logic does use the light field data torefocus in the z-direction as slit 450 is moved along the x-direction.Thus, instead of simply simulating a horizontal movement of the slitlamp, controller 300 or 400 would focus posteriorly slightly as the exammoved away from the corneal apex towards the peripheral cornea in orderto follow the corneal curvature. In another embodiment of the apparatus,the software logic would use light-field data to selectively focus theimage along the curved y-direction of the cornea in the same manner asillustrated for the x-direction, so that instead of focusing in oneplane, the focus could be “wrapped’ along the curved surface of the eye.Referring to FIG. 24D, an example is shown of the focus plane in the Ydirection for the slit position shown in FIG. 20 (the line of light isrepresented at five discrete points for purposes of illustration)wherein the software logic does not use the light field data to refocusin the z-direction. In contrast, as shown in FIG. 24E, an example isshown for the slit position shown in FIG. 20 wherein the software logicdoes use the light field data to refocus in the z-direction. Thus,controller 300 or 400 would focus posteriorly slightly for positionsoffset from the corneal apex in the y-direction in order to follow thecorneal curvature. In one embodiment, the software logic uses the lightfield data to bring the entire cornea into focus by following thecorneal curvature in both the x-direction and the y-direction. In oneembodiment, controller 300 or 400 assumes the corneal curvature to havea 7.8 mm radius of curvature in the defocus calculations.

Referring to FIG. 25, an optical microscope 500 is illustrated. Opticalmicroscope 500 is an exemplary imaging system for imaging at least aportion of an object of interest 502. An exemplary object of interest isthe eye 10 of a patient. An exemplary optical microscope 500 is anoperating microscope used during surgical procedures. Optical microscope500 includes a support 504 adapted to support the object of interest502. In the case of the eye 10, an exemplary support may be patientsupport 206 described herein in connection with FIG. 6. Opticalmicroscope 500 further includes an Illumination system 506 including alight source 508. Illumination system 506 produces light to illuminatethe object of interest 502.

Optical microscope further includes an observation system 540 includinga first observation unit 510 and a second observation unit 530. Firstobservation unit 510 includes imaging optics 512 configured to receiveimaging rays produced by reflection of light from the object of interest502. The imaging optics 512 provide an image of a desired object plane550 of the object of interest. First observation unit 510 furtherincludes a viewfinder 514 through which an operator may view the imageformed by optics 512. The light travels through a beam splitter 520 toreach viewfinder 514.

As is known in the art, a spacing or other characteristic of optics 512may be altered to offset the focus of the imaging optics 512 from thedesired object plane to an offset object plane 552. This is done toallow the operator of the first observation unit 510 to take intoaccount the optical power of the viewfinder and/or the optical power ofthe operator's eyes. Thus, the image formed by imaging optics 512 alonewill not be of the desired object plane 550, but rather an offset plane552 from the first object plane to take into account the optical powerof the viewfinder 514 and/or operator's eyes. In FIG. 25, input devices518 are provided to make such adjustments to imaging optics 512.Exemplary input devices include keys, buttons, joysticks, dials,switches, and other devices which control the imaging characteristics ofoptics 512

Second observation unit 530 shares the imaging optics 512 and beamsplitter 520 with first observation unit 510. Second observation system530 further includes a plenoptic camera 130 which is coupled to acontroller 300. Controller 300 displays an image captured by plenopticcamera 130 on a display 532.

A person viewing the image displayed with display 532 may not besatisfied with the focus of the image because it is not focused at thedesired object plane 550. As stated earlier, the operator of firstobservation system 510 has set the characteristics of imaging optics 512to provide the desired image through view finder 514. This may result ina fuzzy image being displayed with display 532. Through input devices360 a person viewing the image displayed with display 532 can utilizethe light field data recorded by plenoptic camera 130 to provide arefocused image on display 532 which is focused at the desired objectplane 550.

In one embodiment, controller 300 includes processing sequences tomonitor one or more portions of eye 10 over time. Controller 300 basedon the received images determines whether a position of a structure ofthe eye 10 has changed over time. In one example, controller 300monitors posterior capsule 30 of eye 10 to determine whether it hasmoved forward towards the anterior portion of eye 10. This type ofmovement is important to note when performing surgery on eye 10, such asproviding a replacement lens 18 for eye 10. During surgery, an openingis provided in the anterior capsule 31 of eye 10 and the removal of lens18 is aided with an ultrasonic probe. The posterior capsule 30 may moveforward during or subsequent to this process. If the probe contacts theposterior capsule 30, the posterior capsule 30 may be punctured.

Referring to FIG. 25A, an exemplary processing sequence 900 isillustrated. Examination system 500 captures images of portions of eye10 over time, as represented by block 902. Controller 300 analyzes theimages to determine the positions of one or more monitored structures ofthe eye 10, as represented by block 904. An exemplary structure isposterior capsule 30. Since the images are taken with a plenoptic camera130, controller 300 may utilize the light field data to determine therelative positions of portions of the eye 10 over time including theposition of the posterior capsule 30.

Controller 300 determines if the one or more monitored structures aremoving towards an unsafe location, as represented by block 906. In thecase of the posterior capsule 30, controller 300 determines whether theposterior capsule 30 is moving forward towards the anterior side of theeye 10. In one example, controller 300 determines whether the movementof the monitored structure has exceeded a threshold amount. If not, thecontroller 300 continues to monitor the position of the one or moremonitored structures of the eye 10. If so, controller 300 providesfeedback to the operator of the movement of the one or more monitoredstructures towards an unsafe location, as represented by block 908.Exemplary types of the feedback include one or more of audio, visual,and tactile outputs. Controller 300 may further provide an input to aninstrument contacting the eye to inhibit further operation of theinstrument, as represented by block 910. In the case of lens removal,the instrument may be an ultrasonic probe and controller 300 may inhibitfurther operation of the probe based on the location or movement of theposterior capsule 30.

Referring to FIG. 25B, an exemplary processing sequence 950 ofcontroller 300 is illustrated. Processing sequence 950 assists a user inselecting an appropriate intraocular lens for placement in an eye duringcataract surgery. Controller 300 analyzes the images taken withplenoptic camera 130 to determine a position of one or more of thecornea 12, the anterior capsule 31, the posterior capsule 30, thecorneal curvature, the position of the suspensory ligaments 34, and theposition of the retina 22, as represented by block 952. In oneembodiment, camera 130 is focused on a first one of the plurality ofanatomical structures and, in order to focus on another one of theplurality of anatomical structures, controller 300 through use of thelight field data defocus the image. Controller 300 then may use thedetermined change in focus distance of the image to determine the offsetdistance from the first anatomical structure and thus obtain a measureof the distance between the two anatomical structures.

Based on the determined positions, controller 300 suggests a firstintraocular lens from a library of intraocular lens, as represented byblock 954. In one embodiment, the first intraocular lens is selectedfrom the library of intraocular lens through a comparison of thedetermined positions to a database of determined positions forhistorical patients and a rating of the selected intraocular lens forthose respective historical patients.

In one example, after the original lens 18 is removed, the space betweenthe anterior capsule 31 and the posterior capsule 30 is filled with afluid. Controller 300 then determines a distance between the anteriorcapsule 31 and the posterior capsule 30. As is known in the art, thisdistance may be used to select the appropriate replacement lens 18 forinsertion into the eye. Controller further determines the position ofthe suspensory ligaments relative to one of the anterior capsule 31 andposterior capsule 30. Controller 300 then searches a database forempirical data of historical patients having similar separations of theanterior capsule 31 and posterior capsule 30 and similar offsets for thesuspensory ligaments 34. The database also includes a measure of thefinal position of lens 18 after healing for those historical patients.If the final position of lens 18 was as expected then controller 300suggests a first lens 18. If the final position of lens 18 was differentthan expected, such as further posteriorly, then controller 300 maysuggest a second lens having a different power than the first lens.

Returning the slit-lamp examples provided herein, in addition tostandard light-field image processing, the apparatus employs softwaretechniques to collate adjacent images for a specific slit-beam size andangular orientation. A library of adjacent images is created and storedthrough the techniques described above. This collection of images isanalogous to the series of instantaneous slit-lamp images seen by anophthalmologist scanning across the eye. Separate libraries of imagescan be created for the slit-views obtained at each slit-beam size andangular orientation. If various slit focal planes are used, separatelibraries are created at each position. The images in these librariescan be cross-referenced to similar images in other slit focal planes.These cross-referenced images would be analogous to the images obtainedby an ophthalmologist moving the slit-lamp joystick posteriorly so viewthe tear film, cornea, anterior chamber, iris, lens and vitreous. Adifferent type of cross-referencing can create a library of imagesanalogous to rotating the slit-beam about a pivot point.

These libraries of images allow the end-user to simulate the effect of aslit-lamp examination by using a trackpad, joystick, keyboard,touch-sensitive display screen or similar controller. Depending on thedefault settings chosen, a given slit image is projected on a displaymonitor. The user can manipulate the controller (joystick, trackpad,keyboard, touch—sensitive display screen) to simulate an x axis movementof the slit-lamp and call up adjacent x-axis images of the ocularstructure of interest. Continued manipulation of the controller in thesame direction would cause adjacent images to be displayed on themonitor to create a motion picture similar to the dynamic view obtainedby an ophthalmologist using a slit-lamp.

Moving the controller in the y-axis would cause an upper or lower partof the captured image to be displayed. Moving the controller in z-axiswould cause a different focal plane to come into focus. These z-axismovements could display a refocused light-field image—or in the case ofa thin slit—a new light-field image of the same position but aposteriorly focused thin slit. In this manner, more anterior orposterior portions of the ocular structure would be visualized. Othercontrollers could call up images with thicker or thinner slit beams tosimulate changing the slit thickness on a slit lamp. Likewise, othercontrollers could call up images with different slit beam orientationsto simulate rotating the slit beam apparatus around its pivot point.

The previously described techniques of imaging use light-fieldphotography to image a slit-beam as it illuminates various structures inthe eye. In another embodiment of the apparatus, the light-fieldphotography is performed without a slit-beam. Instead diffuseillumination is used, but during the viewing mode software selectivelyilluminates certain pixels so that a virtual slit effect is obtained.The end user can then use a mouse, joystick, keyboard, trackpad,touch-sensitive screen or similar controller to manipulate the virtualslit to simulate an entire slit-lamp exam. The advantage of thisapproach would be the elimination of the need for multiple slit-beampasses of the eye structures and the computing power necessary toperform the light-field photography reconstructions. Similarly, insteadof illuminating certain pixels, another embodiment of the device usesbright diffuse illumination of the eye structures, and then softwareselectively dims the brightness of the majority of the image pixels,leaving only those pixels in a virtual slit configuration at thebrightest level. Software can selectively create the inverse of thistype of image (dimmed slit-beam in a brightly illuminated field) as thismay allow for diagnostic views not possible in any conventional slitlamp examination.

The software portion of the apparatus allows for various playback andsharing settings. Comparison of a current examination to previousexaminations can be made through side-by-side or overlay display. Slitlamp images can be made available to patients or other professionalseither in raw form allowing the user to “drive through” the exam again,or a through a summary video created from the raw data.

One embodiment of the device adapts the plenoptic camera and logicsystems described above to be used in conjunction with an operatingmicroscope. This embodiment uses the light-field data and a processor toadjust the z-plane focus in real-time to either a user-defined plane ora plane chosen by an image recognition and tracking system locked on topertinent eye anatomy such as the surgical limbus, conjunctival vesselsor iris aperture. The x and y-axis can also be tracked using thissystem. Alternatively, the device allows for post-surgical adjustmentsof the z-axis focal plane and x- and y-axis orientation to allow forless fatiguing viewing of surgical video or for the post-processing ofsurgical video for educational dissemination.

One embodiment of the device uses a gonioscopic lens attachment topermit ophthalmologic viewing of the filtration angle structures of theeye using the slit-lamp, plenoptic camera and logic systems describedabove.

One embodiment of the device uses a fundus lens attachment similar to aa Hruby lens, 78 diopter, 90 diopter or Volk Superfield lens to permitophthalmologic viewing of the posterior vitreous and retina using theslit-lamp, plenoptic camera and logic systems described above.

One embodiment of the device uses a Goldmann tonometer attachment to theslit-lamp, plenoptic camera and logic systems described above tofacilitate the measurement of the intraocular pressure in the eye.

One embodiment of the device optimizes the optics to examine thestructures of the eye through the use of specular reflection. Thisembodiment allows for qualitative and quantitative evaluation of thecorneal endothelium and includes the measurement of the endothelial cellcount.

Other embodiments of the device combine the plenoptic imaging systemwith other established ocular imaging systems including but not limitedto ocular coherence tomography, scanning laser ophthalmoscopy, and laserinterferometry using the same or different patient support 210, the sameor different controller 300, memory 430, processor(s) 450, input devices360, output devises 362, and remote controller 400.

One embodiment of the device uses a Nd-YAG, argon, excimer, femtosecondor other laser in conjunction with the slit-lamp microscope, plenopticcamera and logic systems described above to treat various eye diseasesand conditions either locally or remotely through a networked system.

One embodiment of the device attaches either a dropper system or a spraysystem to the slit lamp microscope to administer ocular pharmaceuticalssuch as anesthetics, dyes, dilating or constricting drops to aid indiagnosis or treatment of eye disease.

One embodiment of the device incorporates the controller 400 into anelectronic medical records system so that the systems described abovecan be accessed and controlled from within a given patient's medicalrecord. A still photo, video or sets of images or videos can beidentified and separately stored in the electronic medical record file.These images or videos can also be printed or electronically to otherproviders or patients either from within the electronic record or fromcontrollers 300 or 400.

Referring to FIG. 26, examination system 100 is shown including a lightsource 600 as part of illumination system 102. Referring to FIG. 27,light source 600 includes a plurality of individual sources 602A-JJ.Although thirty-six light sources 602 are illustrated, light source 600may include fewer or additional light sources 602. Returning to FIG. 26,light source 600 is operably coupled to controller 300 which controlsthe optical characteristics of each of light sources 602A-JJ. Controller300 may increase or reduce in intensity level of one or more of lightsources 602A-JJ and/or alter a wavelength characteristic of one or moreof light sources 602A-JJ. In one embodiment light sources 602A-JJ aredimmable light sources, such as an LED light sources. In anotherembodiment light sources 602A-JJ are dimmable light sources, such as LEDlight sources, that also have selectable wavelength spectrums(color-changing) of the emitted light.

In one embodiment the slit lamp 200 illustrated in FIG. 6 includes lightsource 600. A user of slit lamp 200 may adjust the opticalcharacteristics of one or more of light sources 602A-JJ through theinput devices of slit lamp 200. Controller 300 will receive therequested adjustments and alter the output of the respective lightsources 602. In one example, the optical characteristics of lightsources 602 are adjusted to selectively illuminate various ocularstructures of interest. For example, one or more of light sources 602may be dimmed or turned off to only illuminate a portion of the eye 10.

In one example, the optical characteristics of light sources 602 areadjusted to increase visibility and minimize artifacts that appear inthe images captured by plenoptic camera 130. For example, a glare region610 is shown in the image of FIG. 8. In one embodiment a user wouldcontrol slit lamp 200 to reduce the intensity level of one or more oflight sources 602 to reduce the amount of light that is incident at theglare region 610 in the image. Thus, the intensity of the glare region610 is reduced. In one example the controller 300 provides the images ofeye 10 on a display, such as the image shown in FIG. 8. A user may thenclick on a region of the image, such as glare region 610, and requestthat the intensity level be raised or lowered for that region.Controller 300 then would raise or lower the intensity level of one ormore of light sources 602 to raise or reduce the light intensity of theselected region, such as glare region 610.

By having individually controllable light sources 602, light source 600is able to output customizable illumination patterns for illuminatingeye 10. Referring to FIG. 28, one example custom illumination pattern isshown wherein the intensity values are represented in a range of 1 to10, with 1 being not emitting light and 10 being maximum intensity. Asshown in FIG. 28, the intensity value for light sources 602V, 602W,602BB, and 602CC are set to 1, which corresponds to those light sourcesbeing turned off. Further, the intensity values of each of light sources602O-R, 602V, 602X, 602AA, 602DD, and 602GG-JJ each have an illuminationlevel equal to 5. The remaining sources 602 all have an intensity levelset to 8. As such, in the illumination pattern shown in FIG. 28 theillumination of light source 600 is reduced in stepwise fashion in alower right quadrant of light source 600.

Referring to FIG. 29, an exemplary processing sequence 650 of controller300 is shown. The examination system 100 captures an image of the objectof interest, illustratively eye 10, with the plenoptic camera 130 asrepresented by block 652. Controller 300 receives a request to alter acharacteristic of the image, as represented by block 654. In oneembodiment, controller 300 receives a request through a selection of aportion of the image shown on a display. Controller 300 then adjusts theoptical characteristic of one or more of light sources 602 to alter thecharacteristic of the image, as represented by block 656. As explainedherein for light source 600, the controller 300 may alter an intensitylevel of one or more light sources 602 and/or a wavelength spectrum ofone or more light sources 602. Controller 300 then captures a new imageof the object of interest, as represented by block 658. If the image isconsidered acceptable, then the image is stored in memory for laterretrieval, as represented by block 660. If the image is not acceptable,controller 300 makes further adjustments to the light source 600 toalter the characteristic of the image, as represented by blocks 662 and656. In one example, controller 300 may lower the intensity level of oneor more of light sources 602 in a first iteration and, in response tothe image being deemed not acceptable, further lower the intensity levelof one or more of light sources 602 in a second iteration. In oneexample the decision of whether the image is acceptable or not is basedupon an input received by controller 300 from the user.

In one embodiment, a characteristic of an image captured by plenopticcamera 130 is altered by controller 300 without modification of acharacteristic of the light source of examination system 100. In oneexample, plenoptic camera 130 is of the type illustrated in FIG. 2B andincludes a mask 180 positioned forward of the sensor array 170.Controller 300 includes a processing sequence to remove glare in thecaptured image. Additional details on computational methods for removingglare from an image are provided in paper titled “Glare AwarePhotography: 4D Ray Sampling for Reducing Glare Effects of CameraLenses,” authored by Agrawal et al., SIGGRAPH 2008, http://www.merl.com,Mitsubishi Electric Research Laboratories, the disclosure of which isexpressly incorporated by reference herein.

Referring to FIG. 30, a modified version of examination system 100 isillustrated. As represented in FIG. 30, plenoptic camera 130 is replacedwith an array of cameras 706. The cameras which make up the array 706may be traditional digital cameras or plenoptic cameras, such asplenoptic camera 130. By having an array of cameras, multiple images ofeye 10 may be captured simultaneously without moving observation system106 relative to eye 10. Controller 300 includes exemplary processingsequences to combine information from the images captured by cameras 710into an image that may be focused at different depths. Exemplarycomputational methodology is described in paper titled “High PerformanceImaging Using Large Camera Arrays,” authored by Wilburn et al., ACMTransactions on Graphics (proceedings SIGGRAPH), Vol. 24, No. 3, pp.765-776, (2005), the entire disclosure of which is expresslyincorporated by reference herein.

Referring to FIG. 31, in one embodiment array of cameras 706 includes aplurality of cameras 710 arranged in a line 712 generally perpendicularto the optical axis 28 of eye 10. Each camera has an optical axis 720that is incident on a portion of the eye. In one example, the opticalaxes 720 are parallel. Each camera 710 may have associated imagingoptics to focus the camera on a portion of the eye. Although aone-dimensional array of cameras is illustrated, it is contemplated tohave multiple rows of cameras above and below the cameras shown in FIG.31. By having multiple cameras 710 simultaneously capture images of eye10 at spaced-apart locations, the scan illustrated in FIG. 12 may becompleted in less time. For example, if camera array 706 includes asufficient number of cameras 710, then the scan illustrated in FIG. 12may be completed in the time it takes to capture a single image witheach camera. As such, no linear movement of the observation system 106relative to eye 10 in directions 146 or 148 would be required tocomplete the exemplary scan of FIG. 12.

Referring to FIG. 32, another arrangement of cameras 710 and cameraarray 706 is illustrated. In the arrangement shown in FIG. 32, cameras710 are angled such that their respective optical axes 712 convergetoward a common spot 714 proximate a structure within or near eye 10.Although a one-dimensional array of cameras is illustrated, it iscontemplated to have multiple rows of cameras above and below thecameras shown in FIG. 31 with their optical axis also converging towardsthe common spot 714. As such, assuming a sufficient number of cameras710, rotational movement of the observation system 106 relative to eye10 would not be required to complete the exemplary scan of FIG. 13. Inone example, the cameras are arranged on an arc. An exemplary arc is acircular arc.

Referring to FIG. 33, an examination system 800 is shown. Examinationsystem 800 includes a support 804 adapted to support a patient and toposition the left and right eyes 10 of the patient. An exemplary supportmay be patient support 206 described herein in connection with FIG. 6.Examination system 800 further includes two illumination systems 806,each including at least one light source 808. Illumination systems 806produce light to illuminate the eyes 10 of the patient. In oneembodiment a single illumination system is used to illuminate both theleft eye 10 and the right eye 10 of the patient.

Examination system 800 further includes two observation systems 820A and820B. Each of the observation systems 820 includes imaging optics 812configured to receive imaging rays produced by reflection of the lightfrom the respective eyes 10 of the patient. The respective imagingoptics 812 provide an image of a desired object plane 850 of the leftand right eye. In particular, observation system 820A images right eye10 and observation system 820B images left eye 10. The imaging rayspassing through imaging optics 812 are provided to respective plenopticcameras 130, which in turn provide images of the respective eye 10 ofthe patient to a controller 300. The images are displayed on anassociated display 814 by controller 300 for observation by a user. Theuser may adjust the intrapupillary spacing between observation systems820A and 820B through input device 818. In one embodiment, bothobservation system 820A and 820B are supported on a support, such asmoveable base 208 of FIG. 6. Observation systems 820A and 820B are ableto move relative to moveable base 208. In one example observationssystems 820A and 820B are able to slide relative to move in a lineardirection relative to moveable base 208. A turnbuckle is coupled to eachof observation systems 820 and turned to alter a spacing betweenobservation systems 820A and 820B. Alternatively, controller 300 mayutilize the light-field images provided by respective plenoptic cameras130 and make adjustments to account for the intrapupillary distancebetween the eyes.

Examination system 800 allows the user to obtain images of both the leftand right eyes 10 of a patient and, subsequent to capturing images, toadjust the depth of focus from object plane 850 to an offset objectplane 852 in order to view other structures of the eye. This allows theoperator to independently change a depth of focus of both the left andright eye images and view various structures of the respective eyes.

In an exemplary embodiment of the present disclosure, an imaging systemfor imaging at least a portion of an eye of a patient is provided. Thesystem comprising a patient support adapted to position the eye of thepatient; a movable base moveable relative to the patient support; and anillumination system. The illumination system including at least onelight source producing light to illuminate the eye and an illuminationsystem support arm supporting the light source. The illumination systemsupport arm being supported by the moveable base and rotatable relativeto the moveable base. The system further comprising an observationsystem including a plenoptic camera configured to receive imaging raysproduced by reflection of light from the eye, and an observation systemsupport arm supporting the imaging system. The observation systemsupport arm being supported by the moveable base and rotatable relativeto the moveable base. The observation system further comprising astorage device operatively coupled to the plenoptic camera to receiveand store a plurality of images of the eye imaged by the plenopticcamera, each of the stored images having at least one associatedcomponent characteristic of one of the patient support, the movablebase, the illumination system, and the observation system. In oneexample, the illumination system further includes a slit forming devicewhich receives illuminating light produced by the at least one lightsource and provides a line of light to illuminate the eye, theillumination system support arm supporting the slit forming device andwherein the plenoptic camera receives imaging rays produced byreflection of the line of light from the eye. In another example, theillumination system includes a plurality of light sources arranged in anarray, the plurality of light sources each produce light to illuminatethe eye. In a variation thereof, an illumination characteristic of aportion of the plurality of light sources is adjusted through an inputdevice. In a refinement thereof, the illumination characteristic is oneof an intensity level and a wavelength spectrum. In another variationthereof, an illumination characteristic of a portion of the plurality oflight sources is adjusted through an electronic controller. In arefinement thereof, the illumination characteristic is one of anintensity level and a wavelength spectrum. In a further example, theobservation system support arm is rotatable relative to the moveablebase independent of the illumination system support arm. In yet afurther example, the illumination system support arm is rotatablerelative to the moveable base about a first rotation axis and theobservation system support arm is rotatable relative to the moveablebase about the first rotation axis.

In another exemplary embodiment, a method of analyzing an eye of apatient which has been illuminated with a slit-lamp microscope isprovided. The slit-lamp microscope including an illumination system andan observation system. The illumination system including a light sourceand a slit forming device which provides a line of light to illuminatethe eye and the observation system including an imaging system includinga plenoptic camera configured to receive imaging rays produced byreflection of the line of light from the eye. The method comprising thesteps of storing a plurality of images of the eye imaged by theplenoptic camera while the eye was illuminated with the line of light,each of the stored images having at least one associated slit-lampmicroscope characteristic; receiving an image request; and providing arequested image based on at least one of the plurality of images, theimage request, and the at least one associated slit-lamp microscopecharacteristic of the at least one of the plurality of images. In oneexample, the requested image includes the line of light focused on afirst portion of a curved structure. In another example, the methodfurther comprises the steps of receiving an image request for a secondimage having the line of light focused on a second portion of the curvedstructure, wherein the line of light is displaced in at least one of anx-axis direction and a y-axis direction and in a z-axis direction; andgenerating the second image from at least one of the stored images andthe light field data of the at least one stored image. In a furtherexample, the method further comprises the step of requesting to walkthrough the stored images sequentially. In yet a further example, themethod further comprises the steps of retrieving an image set from aprior examination; and identifying an image from the prior examinationhaving the same associated slit-lamp microscope characteristic as therequested image. In yet a further example, the associated slit-lampmicroscope characteristic is one or more of an x-axis position of amoveable base of the slit-lamp supporting the illumination system andthe observation system, a y-axis position of the moveable base, a z-axisposition of the moveable base, a rotational position of the illuminationsystem, a rotational position of the observation system, a slit width ofthe slit-forming device, and a magnification of the observation system.In still yet another example, the method further comprises the steps ofreceiving an image request for a second image having the line of lightfocused on at a different depth within the eye than the first image; andgenerating the second image from at least one of the stored images andthe light field data of the at least one stored image.

In yet another exemplary embodiment of the present disclosure, animaging system for imaging at least a portion of an eye of a patient isprovided. The system comprising a patient support adapted to positionthe eye of the patient; an illumination system including a light sourceproducing light to illuminate the eye; and an observation systemincluding a plurality of cameras in a spaced apart arrangement, eachcamera positioned to receive imaging rays produced by reflection oflight from the eye. In one example, each camera has an optical axis andthe plurality of optical axes are parallel. In another example, theplurality of cameras are arranged along a line generally perpendicularto the optical axes of the plurality of cameras. In a further example,each camera has an optical axis and the plurality of optical axesconverge towards a common point. In a variation thereof, the pluralityof cameras are arranged along an arc. In a refinement thereof, the arcis a circular arc and the common point is a center of the circular arc.In still another example, the plurality of cameras are plenopticcameras.

In a further exemplary embodiment of the present disclosure, a method ofanalyzing an eye of a patient is provided. The method comprising thesteps of illuminating the eye with an illumination system, theillumination system including a light source and a slit forming devicewhich provides a line of light to illuminate the eye; positioning afirst camera relative to the eye to receive imaging rays produced by areflection of the line of light from the eye; positioning a secondcamera relative to the eye to receive imaging rays produced by thereflection of the line of the light from the eye; and storing aplurality of images of the eye imaged by the first camera and the secondcamera while the eye was illuminated with the line of light. In oneexample, each of the first camera and the second camera have an opticalaxis which are parallel to each other. In a variation thereof, the firstcamera and the second camera are arranged along a line generallyperpendicular to the optical axes of the first camera and the secondcamera. In another example, each of the first camera and the secondcamera have an optical axis that converge towards a common point. Inanother variation thereof, the first camera and the second camera arearranged along an arc. In a refinement thereof, the arc is a circulararc and the common point is a center of the circular arc. In a furtherrefinement thereof, the plurality of cameras are plenoptic cameras.

In yet a further exemplary embodiment of the present disclosure, animaging system for imaging at least a portion of an eye of a patient isprovided. The system comprising a patient support adapted to positionthe eye of the patient; an illumination system including a light sourceproducing light to illuminate the eye; and an observation systemincluding imaging optics configured to receive imaging rays produced byreflection of light from the eye which are focused by the imaging opticsat a first object plane, a first observation unit including a viewfinderwhich receives imaging rays from the imaging optics and a secondobservation unit which receives the imaging rays from the imagingoptics, the second observation unit including a plenoptic camera and adisplay, the second observation unit displaying an image of the eyegenerated based on the imaging rays, the image of the eye being focusedat a second object plane spaced apart from the first object plane. Inone example, the imaging system further comprises a beamsplitter, theimaging rays reaching the viewfinder through a first path through thebeamsplitter and reaching the plenoptic camera through a second paththrough the beamsplitter. In another example, the first object plane isoffset from the second object plane. In a further example, theillumination system includes a plurality of light sources arranged in anarray, the plurality of light sources each produce light to illuminatethe eye. In a variation thereof, an illumination characteristic of aportion of the plurality of light sources is adjusted through an inputdevice. In a refinement thereof, the illumination characteristic is oneof an intensity level and a wavelength spectrum.

In yet still another exemplary embodiment of the present disclosure, amethod of analyzing an eye of a patient is provided. The methodcomprising the steps of illuminating the eye with an illuminationsystem; receiving with imaging optics imaging rays produced byreflection of light from the eye; directing the imaging rays to aviewfinder; directing the imaging ray to a plenoptic camera; focusingthe imaging optics on a first object plane in the eye; and displaying ona display operatively coupled to the plenoptic camera a second objectplane in the eye. In one example, the first object plane is offset fromthe second object plane. In a variation thereof, the first object planetake into account at least one of an optical power of the viewfinder andthe optical power of an operator's eyes such that the resultant imageviewed by the operator through the viewfinder is focused at the secondobject plane.

In still a further exemplary embodiment of the present disclosure, animaging system for imaging at least a portion of a left eye of a patientand at least a portion of a right eye of the patient is provided. Thesystem comprising a patient support adapted to position the left eye andthe right eye of the patient; at least one illumination system includingat least one light source producing light to illuminate the left eye andthe right eye; a first observation system including a first plenopticcamera configured to receive imaging rays produced by reflection oflight from the left eye; a second observation system including a secondplenoptic camera configured to receive imaging rays produced byreflection of light from the right eye; and a storage device operativelycoupled to the first plenoptic camera and to the second plenoptic camerato receive and store a plurality of images of the eye imaged by thefirst plenoptic camera and the second plenoptic camera. In one example,the at least one illumination system includes a first illuminationsystem including at least a first light source producing light toilluminate the left eye and a second illumination system including atleast a second light source producing light to illuminate the right eye.

In a further exemplary embodiment of the present disclosure, a method ofanalyzing an eye of a patient with an imaging system including anillumination system and an observation system is provided. Theillumination system includes a light source. The observation systemincluding an imaging system including a camera configured to receiveimaging rays produced by reflection of light from the eye. The methodcomprising the steps of capturing images of a portion of the eye overtime with the camera; monitoring a position of a structure of the eye inthe captured images; determining if the structure of the eye is movingtowards an unsafe location; and if the structure is moving towards anunsafe location, providing feedback of such movement. In one example,the method further comprises the step of providing a signal to inhibitoperation of an instrument which is used to alter a portion of the eye.In a variation thereof, the instrument is an ultrasound probe. Inanother example, the step providing feedback of such movement includesat least one of providing an audio output, providing a visual output,and providing a tactile output. In a further example, the camera is aplenoptic camera. In a variation thereof, the structure is a posteriorcapsule of the eye and the step of determining if the structure of theeye is moving towards the unsafe location includes the step ofdetermining if the posterior capsule is moving forward towards theanterior side of the eye. In a refinement thereof, the step ofdetermining if the structure of the eye is moving towards the unsafelocation includes the step of determining whether the movement of thestructure has exceeded a threshold amount. In yet a further example, thestep of determining if the structure of the eye is moving towards theunsafe location includes the step of determining whether the movement ofthe structure has exceeded a threshold amount.

In a yet further exemplary embodiment of the present disclosure, amethod of analyzing an eye of a patient with an imaging system includingan illumination system and an observation system is provided. Theillumination system includes a light source. The observation systemincluding a camera configured to receive imaging rays produced byreflection of light from the eye. The method comprising the steps ofcapturing images of a portion of the eye over time with a plenopticcamera; determining positions of one of more structures of the eye fromthe captured images; and identifying a first intraocular lens from alibrary of intraocular lenses for placement in the eye based on thedetermined positions. In one example, the step of identifying the firstintraocular lens from the library of intraocular lenses for placement inthe eye based on the determined positions includes the step of comparingthe determined positions of the one or more structures of the eye with adatabase of determined positions for historical patients and a rating ofthe selected intraocular lens for the historical patients. In avariation thereof, the determined positions includes a distance betweenan anterior capsule of the eye and an posterior capsule of the eye and aposition of suspensory ligaments of the eye relative to one of theanterior capsule and the posterior capsule. In a refinement thereof, thedatabase also includes a measure of the final position of a replacementlens of the historical patients and the step of identifying a firstintraocular lens identifies the a first lens if the measure has a firstvalue indicating the final position of the lens for a historical patientwas as expected and a second lens if the measure has a second valueindicating that the final position of the lens for the historicalpatient was different than expected, the second lens having a differentoptical power than the first lens.

In still another exemplary embodiment of the present disclosure, animaging system for imaging at least a portion of an eye of a patient isprovided. The system comprising a patient support adapted to positionthe eye of the patient; an illumination system including a plurality oflight sources, each producing light to illuminate the eye; and anobservation system including imaging optics configured to receiveimaging rays produced by reflection of light from the eye. In oneexample, the observation system includes a plenoptic camera whichreceives the imaging rays from the imaging optics. In a variationthereof, the imaging system further comprises a storage deviceoperatively coupled to the plenoptic camera to receive and store aplurality of images of the eye imaged by the plenoptic camera, each ofthe stored images having at least one associated componentcharacteristic of one of the illumination system and the observationsystem. In another example, the illumination system further includes aslit forming device which receives illuminating light produced by the atleast one light source and provides a line of light to illuminate theeye and wherein the plenoptic camera receives imaging rays produced byreflection of the line of light from the eye. In still another example,the plurality of light sources are arranged in an array. In a variationthereof, an illumination characteristic of a portion of the plurality oflight sources is adjusted through an input device. In a refinementthereof, the illumination characteristic is one of an intensity leveland a wavelength spectrum. In another variation, an illuminationcharacteristic of a portion of the plurality of light sources isadjusted through an electronic controller. In a refinement thereof, theillumination characteristic is one of an intensity level and awavelength spectrum.

In still another exemplary embodiment of the present disclosure, amethod of analyzing an eye of a patient is provided. The methodcomprising the steps of illuminating the eye with an illuminationsystem, the illumination system including a plurality of light sources;receiving with imaging optics imaging rays produced by reflection oflight from the eye; directing the imaging rays to a camera to capture animage; displaying the image; and adjusting an illuminationcharacteristic of a portion of the plurality of light sources to alteran illumination of a portion of the eye. In one example, theillumination characteristic is one of an intensity level and awavelength spectrum. In another example, the illumination characteristicis adjusted to reduce glare at the portion of the eye.

Various modifications and additions can be made to the exemplaryembodiments discussed without departing from the scope of the presentinvention. For example, while the embodiments described above refer toparticular features, the scope of this invention also includesembodiments having different combinations of features and embodimentsthat do not include all of the described features. Accordingly, thescope of the present invention is intended to embrace all suchalternatives, modifications, and variations as fall within the scope ofthe claims, together with all equivalents thereof.

We claim:
 1. A method of analyzing an eye of a patient which has beenilluminated with a slit-lamp microscope, the slit-lamp microscopeincluding an illumination system and an observation system, theillumination system including a light source and a slit forming devicewhich provides a line of light to illuminate the eye and the observationsystem including an imaging system including a camera configured toreceive imaging rays produced by reflection of the line of light fromthe eye, the method comprising the steps of: storing a plurality ofimages of the eye imaged by the camera while the eye was illuminatedwith the line of light, each of the stored images having one or moreassociated slit-lamp microscope characteristics; providing a first imagebased on the stored plurality of images, the first image having the lineof light focused on a first portion of the eye; receiving an imagerequest altering a relationship between the line of light and the eye;and providing a second image based on the stored plurality of images andthe requested altered relationship between the line of light and theeye, wherein the second image is provided by searching the plurality ofstored images to determine an image having an associated slit-lampmicroscope characteristic that is closest to a desired slit-lampmicroscope characteristic.
 2. The method of claim 1, wherein the one ormore associated slit-lamp microscope characteristics include one or moreof an x-axis position of a moveable base of the slit-lamp supporting theillumination system and the observation system, a y-axis position of themoveable base, a z-axis position of the moveable base, a rotationalposition of the illumination system, a rotational position of theobservation system, a slit width of the slit-forming device, and amagnification of the observation system.
 3. The method of claim 1,wherein the one or more associated slit-lamp microscope characteristicsinclude one or more of an x-axis position of a moveable base of theslit-lamp supporting the illumination system, a y-axis position of themoveable base, a z-axis position of the moveable base, a rotationalposition of the illumination system, a rotational position of theobservation system, a slit width of the slit-forming device, and amagnification of the observation system.
 4. The method of claim 1,wherein the one or more associated slit-lamp microscope characteristicsinclude one or more of an x-axis position of a moveable base of theslit-lamp supporting the observation system, a y-axis position of themoveable base, a z-axis position of the moveable base, a rotationalposition of the illumination system, a rotational position of theobservation system, a slit width of the slit-forming device, and amagnification of the observation system.
 5. The method of claim 1,wherein the image request is received over a network from a controllerremote from the slit-lamp microscope.
 6. The method of claim 1, whereinthe second image is provided over a network from a controller remotefrom the slit-lamp microscope.
 7. The method of claim 1, wherein theimage request includes the desired slit-lamp microscope characteristic.8. The method of claim 1, further comprising the step of generating aplurality of image libraries from the stored plurality of images.
 9. Themethod of claim 1, wherein each of the plurality of stored images has anassociated light field data.
 10. The method of claim 1, wherein thesecond image is based on an associated light field data of a storedimage of the plurality of images.
 11. The method of claim 1, wherein thecamera is a plenoptic camera.